NHS Constitution for England

The NHS constitution for England is a formal constitution which, in one document, lays down the objectives of the National Health Service (or NHS), the rights and responsibilities of the various parties involved in health care in England, (patients, staff, trust boards) and the guiding principles which govern the service.^[1] First published on 21 January 2009 it was one of a number of recommendations in Lord Darzi’s report ‘High Quality Care for All’ as part of a ten-year plan to provide the highest quality of care and service for patients in England.^[2] Previously these rights and responsibilities had evolved in common law or through UK or EU law, or were policy pledges by the NHS and government have now been written into the constitution.

The NHS grants patients rights which are intended to be legally enforceable and also makes other non-binding pledges. These are in the areas of access; quality of care and encvironment; access to treatments, medicines and screening programmes; Respect, consent and confidentiality; informed choice; patient involvement in healthcare and public involvemenst in the NHS; and complaints and redress.

The Constitution is a fairly brief document that is written in plain terms and is simple to understand. Accompanying the constitution is a handbook which gives more information to patients and staff about the constitution, a statement of NHS accountability gives a clear account of the NHS system of accountability and responsibility.

1 Guiding principles
2 Access to Health Care
3 Quality of Care and Environment
4 Approved treatments, drugs and programmes
5 Respect, consent and confidentiality
6 Informed Choice
7 Involvement in one's own health care and in the NHS
8 Rights of redress
9 References
10 External links

Guiding principles

In summary, the guiding principles of the NHS are that

The NHS provides a comprehensive service, available to all irrespective of age, gender, disability, race, sexual orientation, religion or belief, respecting their human rights.
Access to NHS services is based on clinical need, not an individual’s ability to pay (except in exceptional circumstances sanctioned by Parliament).
The NHS aspires to the highest standards of excellence and professionalism to provide high quality care that is safe, effective and focused on the patient experience.
NHS services must reflect the needs and preferences of patients, their families and their carers.
The NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population. The NHS is an integrated system of organisations and services bound together by the principles and values reflected in the Constitution.

Access to Health Care

The constitution defines RIGHTS regarding access to health care which will be

free of charge
non-discriminatory
never refused on unreasonable grounds
obtainable from any UK NHS provider or with pre-approval from any EEA or Swiss public provider
assessed by the local NHS to meet locally assessed needs

The NHS also make pledges that access to health care will be convenient and easy to access within defined waiting times; based on decision making that will be clear and transparent, and that transfers from one provider to another will be as smooth as possible and that patients will be involved in all relevant discussions.

Quality of Care and Environment

The constitution defines RIGHTS regarding qualilty of care and environment as follows

treatment with a professional standard of care, by appropriately qualified and experienced staff, an organisation that meets required levels of safety and quality.
Patients can expect NHS organisations to monitor, and make efforts to improve, the quality of healthcare they commission or provide

add pledges that services will be provided in a clean and safe environment that is fit for purpose, based on national best practice and that there will be a continuous improvement in the quality of services, identifying and sharing best practice.

Approved treatments, drugs and programmes

The constitution defines rights regarding approved treatments, drugs and programmes. Patients have the right to

drugs and treatments that have been recommended by NICE for use in the NHS, if their doctor says they are clinically appropriate for them.
expect local decisions on funding of other drugs and treatments ^[3] to be made rationally following a proper consideration of the evidence. If the local NHS decides not to fund a drug or treatment that you and your doctor feel would be right for you, the local NHS must explain that decision.
receive the approved vaccinations under an NHS-provided national immunisation programme.

and pledges to provide screening programmes as recommended by the UK National Screening Committee.

Respect, consent and confidentiality

With regard to RIGHTS regarding Respect, consent and confidentiality the NHS constitution gives patients the right to

be treated with dignity and respect.
accept or refuse treatment that is offered, and not to be given any examination or treatment without valid consent.
be given information about your proposed treatment in advance, including any significant risks and any alternative treatments which may be available, and the risks involved in doing nothing.
privacy and confidentiality and to expect the NHS to keep their confidential information safe and secure.
access to their own health records. which will always be used to manage treatment in the patient's best interests.

and pledges that it will share with patients any letters sent between clinicians about their care.

Informed Choice

Patients are given rights under the constitution in relation to informed choice including the right to

choose their own GP practice, and to be accepted by that practice unless there are reasonable grounds to refuse
express a preference for using a particular doctor within your GP practice, and for the practice to try to comply.
make choices about their NHS care and to information to support these choices.

The NHS also pledges to inform patients about the healthcare services available locally and nationally and will offer easily accessible, reliable and relevant information to enable patients to participate fully in their own healthcare decisions and to support them in making choices. This includes information on the quality of clinical services where there is robust and accurate information available.

Involvement in one's own health care and in the NHS

The NHS recognized fully that the population has RIGHTS regarding Involvement in their own health care and in the NHS. There are rights to

be involved in discussions and decisions about one's own health care, and to be given information to enable one to do this
be involved, directly or through representatives, in the planning of health care services, the development and consideration of proposals for changes in the way those services are provided, and in decisions to be made affecting the operation of those services.

The NHS also pledges to provide the information needed for the people to influence and scrutinise the planning and delivery of NHS services and to work in partnership with patients, their family, carers and their representatives. It also pledges continuous improvement in the quality of services provided, identifying and sharing best practice in quality of care and treatments.

Rights of redress

When complaining or seeking redress, patients are given RIGHTS to

have any complaint made about NHS services dealt with efficiently and to have it properly investigated.
know the outcome of any investigation into a complaint.
take a complaint to the independent Health Service Ombudsman, if they are not satisfied with the way your complaint was dealt with by the NHS.
make a claim for judicial review if they think they have been directly affected by an unlawful act or decision of an NHS body.
compensation where they have been harmed by negligent treatment.

The NHS also pledges to ensure patients are treated with courtesy and receive appropriate support throughout the handling of a complaint, and the fact that they have made a complaint will not adversely affect their future treatment. When mistakes happen, the NHS promises to acknowledge them, apologise, explain what went wrong and put things right quickly and effectively. It promises that the organisation will learn lessons from complaints and will use them to improve NHS services.

References

^ http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_093419 NHS Constitution for England
^ Sourced from the National Archives
^ In practice, the vast majority of drugs and treatments are available through the NHS but have NOT been explicitly approved by NICE or local NHS management but usage is simply accepted medical practice. This statement makes it clear that NICE decisions rule nationally and overrides local NHS management and in the absence of other guidance from local NHS management then responsibility lies with the doctor and patient together. NICE was originally established to guide national policy where there were significant differences of opinion between the different local NHS organizations over certain drugs and treatments – the so called postcode lottery, but local managements have generally had powers over budgets and coverage in their local area.